Dental Benefits
Xavier offers two dental plans through Superior Dental Care (SDC). The dental plans cover routine cleanings and can help offset additional expenses from basic to major services
In-Network Coverage
| Open Access Network | ||
| In-Network Benefits | Core Plan | Enhanced Plan |
|
Deductible (Calendar Year) |
$50 single, $150 maximum per family* | $50 single, $150 maximum per family* |
| Annual Maximum (Calendar Year) | $1,000 per plan participant excluding Orthodontic Services | $1,250 per plan participant excluding Orthodontic Services |
| Preventive & Diagnostic | Covered In Full | Covered In Full |
| Basic Services (fillings, root canal, extractions, periodontal, endodontic) | 50% Coinsurance Subject to Annual Maximum | 60% Coinsurance Subject to Annual Maximum |
| Major Services (crowns, bridges, dentures) | N/A | 40% Coinsurance Subject to Annual Maximum |
| Orthodontia (children under age 19 ) | N/A | 50% Coinsurance Subject to Lifetime Maximum |
| Orthodontia Lifetime Maximum | N/A | $500 per eligible plan participant |
*family=Employee plus any one or more additional family member(s)
Out-of-Network Coverage
Any out-of-network service may be subject to a 'balance bill' for any amount that the dentist's charge exceeds SDC's allowable amount for an eligible service
SDC Resources
Use www.superiordental.com or the SDC mobile app to:
- view plan details
- view and print your ID card
- find a dentist
SDC Contact Information
6683 Centerville Business Pkwy
Dayton, OH 45459
Phone: 937-438-0283 or Toll-Free 800-762-3159
Fax: 937-291-8695
Plan Information
Core Plan:Group: A48730800
Plan Number:1376
Enhanced Plan:
Group Number: A48730802
Plan Number: 1375